Does G57.91 require prior authorization?

No, G57.91 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`G57.91`, Unspecified mononeuropathy of right lower limb

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.

Key Coverage Criteria

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.

20 Active Policies

CGS-J15-L39940, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L39940, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

WPS-J5-L39987, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

A59906, Billing and Coding: MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A57480, Billing and Coding: Psychiatry and Psychology Services

WPS-J5-L34616, Psychiatry and Psychology Services

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

NGS-J6-L36850, Peripheral Nerve Blocks

A57452, Billing and Coding: Peripheral Nerve Blocks

WPS-J8-L39987, MolDX: Molecular Testing for Identification and Management of Hereditary Transthyretin Amyloidosis

WPS-J8-L34594, Nerve Conduction Studies and Electromyography

WPS-J8-L34616, Psychiatry and Psychology Services

FIRST_COAST-L34859, Nerve Conduction Studies and Electromyography

A57123, Billing and Coding: Nerve Conduction Studies and Electromyography

FIRST_COAST-L33933, Peripheral Nerve Blocks

`G57.91`, Unspecified mononeuropathy of right lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G57.91, Unspecified mononeuropathy of right lower limb

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G57.91`, Unspecified mononeuropathy of right lower limb